Doctor’s Blog

Shoulder Pain

You Can Reach Relief

Shoulder pain is both common and debilitating, with a reported annual incidence of 11.2 cases per 1000 patients in primary care and a lifetime prevalence of up to 67%. Furthermore, recovery from shoulder pain is often slow with high recurrence rates. Of those affected by shoulder pain, 25% report having a previous episode, and 40 to 50% report persisting pain or recurrence at 12-month follow-up. Fortunately, shoulder conditions can be managed conservatively and surgically, depending on the patient and the degree of injury.

Your shoulder is the most mobile joint in the body and affords a wide range of motion and versatility. However, you pay a price for mobility through instability and risk of injury.

I’ll cover common causes of shoulder pain along with general treatment options. See your doctor for detailed information about your specific shoulder pain.

Anatomy

Your shoulder is made of multiple joints between the humerus (upper arm), clavicle (collarbone), and scapula (shoulder blade). The head of your humerus fits into a bony socket in your shoulder blade. The supraspinatus, infraspinatus, teres minor, and subscapularis attach the humerus to the shoulder blade and stabilize the humeral head during overhead arm motions and assist in the elevation and rotation of the shoulder. These muscles are known as the rotator cuff.

These muscles can be pinched, become inflamed, or tear.

Inflammation

Tendons firmly adhere each end of a muscle to a bone. Bursae cushion and protect tendons as well as reduce wear and tear from gliding muscles and nearby bone. Excessive use and repetitive stress of your shoulder can lead to inflammation and swelling of both tissues.

Tendon Tear

Partial or complete tearing or splitting of a tendon can result from long-term wear and tear or sudden injury and trauma. In particular, rotator cuff tendon tears are common and sometimes elicit little or no pain.

Impingement

Repeated overhead movements can compress the tissue between the top of the arm bone and the top of the shoulder blade and result in inflammation and swelling. The tissue can weaken or tear if the movement is continued despite pain and inflammation.

Signs and Symptoms

Reduced Range of Motion

Pain With Arm Movement

Weakness

With subacromial bursitis, rotator cuff tendinitis, and partial rotator cuff tears pain is worse between 60° and 120° (painful arc of motion) of shoulder abduction or flexion and minimal or absent at < 60° or > 120°. Often pain is experienced as a dull ache that is hard to localize along with weakness into external rotation.

Self Care

Activity Modification

Rest along with altering activities to avoid painful movements allow healing and insight into the root cause. NSAIDs such as aspirin and ibuprofen can be used for a limited time and are not meant to be lived on.

Improve Flexibility and Strength

Stretching is a simple and effective way to restore the muscular balance between the shoulder muscles. Strength training of the rotator cuff in conjunction with stretching can have a profoundly positive effect. The American Academy of Orthopaedic Surgeons shoulder conditioning program is a great place to start.

Professional Care

Conservative

When shoulder pain is nonresponsive or progressive professional care should be utilized. Conservative care such as Chiropractic, Physical Therapy, Acupuncture, and Massage Therapy can be wonderful in improving and resolving shoulder pain.

An additional step is to have these muscles evaluated by a practitioner that uses Advanced Muscle Integration Technique (AMIT). Such a practitioner identifies muscles that are unable to hold strong under stress and re-integrates those weak muscles back into their properly functioning group.

Surgery

The majority of shoulder pain responds well to simple treatment methods such as altering activities, rest, stretching and exercise. Chronic dislocations and some rotator cuff tears do not benefit from exercise. In these situations, surgery may be recommended to remove scar tissue or repair damaged tissues.

If you have unresolved shoulder pain sidelining you let us at Clear Point Wellness get you back in action.

Do you have knee pain when running?

Running continues to be the sport of choice for many because of its beneficial health effects, convenience, and economic nature. In 2016, an estimated 64 million Americans went jogging or running. However, running correlates with a high rate of injury, even with all the benefits. Researchers have found that the overall yearly incidence rate for running injuries varies between 37 and 56%, and it could be even higher. Unbelievably, there is no difference in injury rate between gender, age, weight, height, or experience. Furthermore, running speed, frequency, surface, and time of day have little or no effect on future injuries after accounting for distance. Of the modifiable risk factors studied, the strongest predictor of future injury is ‘weekly distance ran’. The most common site of injury is the knee, with Iliotibial Band Syndrome (ITBS) being its second leading cause.

Anatomy Sprint

The iliotibial band is a vertical thickening of fascia running outside the hip to just below the knee. The IT band functions to stabilize the knee laterally and assist the tensor fascia lata and glute max in abduction, extension, and lateral rotation of the thigh. Knee stability is crucial to the longevity of both the athlete and the joint.

Fat or Friction?

As the knee bends during running, the lower part of the ITB rubs across the side of the femur. The friction from rubbing may cause inflammation and pain, know as Iliotibial Band Syndrome. An emerging theory proposes that injury may be associated with fat compression beneath the tract. Unfortunately, the initial cause of either scenario is still up for debate. Whatever the mechanism of injury, Iliotibial Band Syndrome can cause significant morbidity and lead to cessation of exercise altogether.

What to do?

Mediation of symptoms can involve stretching, massage, and use of foam rollers at the site of pain and inflammation. However, addressing the cause will lead to lasting relief and function. In particular, hip abductor weakness seems to contribute to the development of Iliotibial Band Syndrome. To combat these factors, it is essential to ensure the strength of these muscle groups. While strength training should be an integral part of any runner’s regimen, an additional step is to have these muscles evaluated by a practitioner that uses Advanced Muscle Integration Technique (AMIT). Such a practitioner identifies muscles that are unable to hold strong under stress and re-integrates those weak muscles back into their properly functioning group. If you have unresolved knee pain sidelining you let us at Clear Point Wellness get you back in action.

How To Be Healthy.

As a chiropractor, I often take on the role of educator to help clients achieve health and wellness goals. This may be recommending types of stretching or exercise; foods to either eat or avoid; and explaining general principles of health. It is easier to shift your perspective on health than it is to hold your hand through every health decision. I want you to see the world and your body in a new light, so you can make informed decisions on your own. This helps you take ownership of your health and drive it, rather than passively wait for someone else to make you well.

A Healthy Viewpoint.

I use a simple analogy that was coined by author Lawrence Leshan of “The Mechanic and The Gardener”. The analogy contrasts the two major philosophies in healthcare–the mechanistic and vitalistic. The mechanistic philosophy of health holds that we are no more than the sum of our parts. That the body is inherently weak and that if something quits working (such as an organ or joint), we can just replace it and keep on living. The vitalistic philosophy suggests that we are more than the sum of our parts. That every aspect of our being works synergistically to produce a thriving and vibrant life.

A mechanic inspects your vehicle, determines what parts are broken and worn down, and then removes and replaces them with new parts. If your brakes are bad, you replace them with new ones. Same for fluids and tires. Traditional medicine takes a similar approach to the human body. Believing that it will eventually break down and fail, MDs look to drugs and surgery to replace failing organs, joints, and biochemical pathways.

A gardener takes a different approach. When a plant or flower is wilting and failing to grow, the gardener makes changes to the environment the plant is in; cultivating its well-being rather than attempting to replace a leaf or a stem. By increasing or decreasing the amount of water and sunlight, and replenishing the soil content, the plant can thrive on its own.

The Big Question.

The question I ask is whether you believe the human body is more like a car or more like a plant? As trivial as this may seem, it is fundamental to how you make health related decisions. A mechanistic view of the body keeps you looking to drugs and surgery as the answer to pain and dysfunction. The mechanistic model also reinforces the mentality of dependence and looking externally for health, rather than looking within.

However, a vitalistic viewpoint will encourage you to find the rootcause of your health issue. You will take the time to cultivate an environment (internal and external) for your health and wellness. This understanding empowers you to look within for healing and take ownership of your health.

Taking Ownership.

If you feel that empowering yourself with your own state of health blames you for your present condition, don’t. You are missing the point. Your body will naturally respond to the stresses you encounter in your life. You will adapt to these stressors for your ultimate advantage of survival and balance within your environment. These adaptations are wonderful, though over time take their toll. Previously overwhelming experiences create holding patterns in the body, and a need for compensation in the musculoskeletal system, which leads to pain and dysfunction. Working with a doctor or therapist to re-engage proper function, and shifting health habits to support a more regenerative state of being will allow you to let your healing potential shine.

Looking within as you answer these important questions every day – does this food/drink/person/state of mind/emotion/environment serve you, or does it bring you more stress that your body needs to adapt to? It empowers you to make choices that support your ability to heal and thrive.

What is your view on this analogy as it relates to your personal health challenges? I’d love to hear your thoughts!